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Two-year follow-up status of emergency department patients with chest pain: Was it panic disorder?

Published online by Cambridge University Press:  21 May 2015

Richard P. Fleet ,
Kim L. Lavoie ,
Jean-Pierre Martel ,
Gilles Dupuis ,
André Marchand  and
Bernard D. Beitman
Richard P. Fleet*
Affiliation:
Research Center, Montreal Heart Institute, Montréal, Que. Department of Psychiatry, Sacré-Coeur Hospital, Montréal Department of Psychology, University of Quebec at Montreal, Montréal
Kim L. Lavoie
Affiliation:
Research Center, Montreal Heart Institute, Montréal, Que. Department of Psychiatry, Sacré-Coeur Hospital, Montréal Department of Psychology, Concordia University, Montréal
Jean-Pierre Martel
Affiliation:
Department of Psychology, University of Quebec at Montreal, Montréal
Gilles Dupuis
Affiliation:
Department of Psychology, University of Quebec at Montreal, Montréal
André Marchand
Affiliation:
Department of Psychology, University of Quebec at Montreal, Montréal
Bernard D. Beitman
Affiliation:
Department of Psychiatry and Neurology, University of Missouri–Columbia, Columbia, Missouri
*
Research Center, Montreal Heart Institute, 5000 Belanger St., Montréal QC H1T 1C8; 514 376-3330 x3654; fax 514 376-1355, [email protected]

Abstract

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Objectives:

We previously reported that 25% (108/441) of consecutive patients presenting to the emergency department (ED) of the Montreal Heart Institute with a chief complaint of chest pain suffered from panic disorder (PD). The purpose of the present study was to re-examine these patients (with and without PD) 2 years after their initial ED visit to determine their psychiatric and psychosocial status.

Methods:

An interviewer, who was kept blind to patients’ initial medical and psychiatric diagnoses, attempted to contact all patients who participated in the initial study by phone. Patients who completed the phone interview were sent a battery of psychological questionnaires by mail.

Results:

A total of 301 (70%) patients completed the phone interview, and 228 (52%) patients completed the self-report questionnaires. Participants and non-participants did not differ with respect to age, gender, initial self-report scores, or initial cardiac or psychiatric diagnoses. At follow-up, significantly (p < 0.05) more PD+ than non-PD (PD–) patients reported: 1) chest pains in the last month (57% vs. 31%); 2) one or more ED consultations in the past year for chest pain (40% vs. 14%); 3) one or more hospitalizations in the past year (31% vs. 11%); and 4) perceiving their general health as “poor” (22% vs. 9%). PD+ patients displayed a significant (p < 0.05) worsening of their panic symptoms, agoraphobic avoidance, depression, and trait anxiety, and reported significantly (p < 0.05) greater suicidal ideation compared to PD– patients (32% vs. 9%). Of all PD+ patients, only 22% (18/82) reported receiving some form of mental health treatment for their symptoms.

Conclusions:

Unrecognized and untreated PD has a chronic and disabling course. Greater efforts should be made to screen for PD in patients complaining of chest pain in EDs.

Keywords

panic disorderchest painemergency departmentoutcome
Type
EM Advances • Innovations en MU
Information
Canadian Journal of Emergency Medicine , Volume 5 , Issue 4 , July 2003 , pp. 247 - 254
Copyright
Copyright © Canadian Association of Emergency Physicians 2003

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